CREDIT CARD '"on file" AUTHORIZATION FORM
IOGLB is authorized to maintain credit card payment information in our confidential files. This
form is being provided for you to supply IOGLB this information for the upcoming license year.
Your signature authorizes us to review this information and deduct fees from the credit card below,
when you sign the applicable application
Outfitter applications, Designated Agent applications, and Guide application forms include a box
that you must sign to authorize use of this credit card for the license fee(s), verbal authorization will not
be accepted at any time.
*******We only accept Mastercard or Visa at this time*******
Outfitter/Designated Agent Signature:
Cardholder Name (as imprinted on credit card)
Credit Card #
Cardholder Authorizing Signature
If anyone other than the cardholder is authorized to use this credit card, please have him
or her print and sign his or her name: